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40000 6 Mile Rd Northville MI 48168-3956 | |
| (248) 374-7400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 40000 6 Mile Rd, Northville, Michigan |
| Authorized Official Name and Position | Bethany Crane (SPECIAL NEEDS DIRECTOR) |
| Authorized Official Contact | 2483745999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
40000 6 Mile Rd Northville MI 48168-3956 Ph: (248) 374-7400 | 40000 6 Mile Rd Northville MI 48168-3956 Ph: (248) 374-7400 |
| NPI Number | 1285471136 |
|---|---|
| Provider Enumeration Date | 07/09/2024 |
| Last Update Date | 12/12/2024 |
| Certification Date | 12/12/2024 |
| Medicare PECOS PAC ID | 7113452277 |
|---|---|
| Medicare Enrollment ID | O20241126002155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285471136 | NPI | - | NPPES |
| Provider Name | Deanette L Wieczorek |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568971133 PECOS PAC ID: 2163786070 Enrollment ID: I20180501000696 |
| Provider Name | Kathleen Fisher |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730648338 PECOS PAC ID: 1658612270 Enrollment ID: I20190409001806 |
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